Workers’ Compensation

Workers’ compensation insurance is vital for small businesses because it helps them cover the cost of medical expenses and lost wages for injured workers. Small businesses need workers’ comp because:

• In most states, workers’ compensation insurance is a requirement
• A major claim can have a devastating financial effect on business operations
• Workers’ compensation helps protect a company’s most valuable asset – their workforce

A Workers’ Compensation policy from AmTrust Financial helps protect businesses and their employees from a workplace injury. Here’s how Workers’ Compensation Insurance from AmTrust works:

• An injured or sick employee seeks medical help and the business submits a workers’ compensation claim with AmTrust, providing details of the incident and the necessary information.
• Our claims experts review the submission and upon approval, the injured employee begins to receive benefits that cover their medical expenses, rehabilitation costs, and lost wages while they are medically unable to work.
• The business can get back to running successfully while the injured employee is on the mend, knowing we’ve got the company covered.

An AmTrust Financial-appointed agent can walk you through the buying process and help you understand the various laws, class codes and underwriting involved with workers’ compensation insurance.

The average cost of workers’ compensation will depend on many factors, including the number of employees, annual payroll, specific occupation and the rate classification of the business.

A few common examples of small business workers’ compensation claims include:

• Slip and fall incidents
• Overexertion or heavy lifting accidents
• Falls from high areas
• Struck by or against objects
• Machinery accidents
• Fires or explosions
• Transportation incidents
• Exposure to dangerous chemicals, substances or environments
• Workplace violence

The main purpose of workers’ compensation insurance is to address legitimate workplace accidents and carelessness. This includes incidents that occur off the employer’s premises but in the service of the job, such as injuries sustained while traveling for work or working remotely.

Workers’ compensation insurance offers five basic benefits:

1. Medical care for the injured worker
2. Temporary disability benefits to make up for lost wages while the injured employee is recovering
3. Permanent disability benefits if an employee can’t return to work
4. Supplemental job displacement benefits, which pay for skill enhancement or retraining if the injured worker can’t return to the job they had before the injury
5. Death benefits paid to a spouse, children or dependents if the worker dies due to job-related injury or illness

While workers’ compensation is no-fault, certain claims generally are not covered, including when:

• A worker intentionally inflicts his or her injuries or illnesses
• The injury or illness occurs while the worker is doing something illegal
• The employee wasn’t on the clock
• The worker’s behavior was in clear violation of company policy or protocol
• The employee was under the influence of drugs or alcohol
• The injury occurs after an individual is laid off or terminated

Read more about what workers’ compensation covers under the course and scope rule.

Step 1: The employee reports an injury to the employer.

Assess the condition of the injured worker. The employee should seek medical attention right away for a serious or life-threatening injury. If it is a non-emergency, the employee should visit a medical provider designated by the employer.

Step 2: The employer files the claim with their insurance carrier.

Upon receipt of the work injury, a supervisor (or H.R. representative) should provide the necessary paperwork to the employee and report the injury to the company’s workers’ compensation insurance provider. All injuries, from minor to major, should be reported within 24 hours of the incident. Learn more about reporting a claim with AmTrust.

Step 3: The insurer will either approve or deny the claim.

The workers’ compensation insurance carrier will determine whether a claim is approved or denied based on the circumstances around the injury.

Step 4: Continue receiving medical treatment and monitor the status of your claim.

The employee continues receiving treatment and may follow up on the status of their claim periodically.

Step 5: The employee returns to work.

Once the injured employee is healthy enough, they will return to work (either full-time or in a limited role) unless the injury leaves them totally disabled.

Here are six signs of a potentially fraudulent workers’ compensation claim:

1. You’ve heard employees gossip about the employee’s injury
2. You can’t get a clear idea of what actually happened from those involved
3. The injured party is refusing diagnostic procedures like an x-ray or MRI
4. There aren’t any witnesses to the injury event
5. The claim is reported on a Monday morning
6. The claim is reported more than seven days after the injury occurred

Individually, these signs do not conclusively mean a workers’ comp injury is false, but when more than three of them are present, it might be time to take a closer look at the situation and the employee’s claim.